Abstrakt Technologie Červenec 2010

Promising new technologies are emerging in digestive surgery: Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Single Port Access Surgery. They both aim to limit the surgical morbidity by decreasing the number of parietal accesses. The feasibility in human is obviously demonstrated, but numerous issues remain concerning the safety of these techniques. Furthermore, the expected advantages are not clearly demonstrated until now in the literature. In the future, it will be advisable to standardize techniques, in order to allow large clinical studies and to limit the potential complications of these approaches.

PURPOSE OF REVIEW: To review the contemporary literature on laparoendoscopic single-site surgery (LESS) advances in gynecology. RECENT FINDINGS: Minimally invasive surgery has become a standard of care for the treatment of many benign and malignant gynecologic conditions. Both conventional laparoscopy and robotic assisted surgery have impacted the entire spectrum of gynecologic surgery. Ongoing efforts to improve upon the morbidity and cosmetic sequelae of laparoscopic surgery have led to minimization of size and number of ports required for these procedures. LESS surgery is a recently coined surgical term used to describe various techniques that aim at performing laparoscopic surgery through a single, small skin incision concealed within the umbilicus.LESS surgery is not a new endeavor but recent developments in surgical technology and techniques have resulted in an exponential increase in utilization of LESS across many surgical subspecialties. Recently published outcome data demonstrate feasibility, safety and reproducibility for LESS in gynecology. The contemporary LESS literature, gamut of gynecologic procedures and limitations of current technology will be reviewed in this article. SUMMARY: LESS represents the latest innovation in minimally invasive surgery but comparative data and prospective trials are required to determine the clinical impact of LESS in treatment of gynecologic conditions.

BACKGROUND: Single-incision laparoscopic surgery is an emerging approach in the field of minimally invasive colon and rectal surgery. This modality utilizes a ‘scarless’ incision concealed within the umbilicus, and results in improved cosmesis with the potential for reduced trauma, pain and length of hospital stay. However, unique technical challenges have curbed its adaptation. Robotic-assisted technique may help overcome these limitations when applied to the single-incision approach. METHODS: A robotic-assisted single-incision laparoscopic partial cecectomy was performed using the da Vinci((R)) robot and the GelPOINT() access device. Modifications of the robotic set-up were utilized to optimize the technique. The robotic instruments were crossed below the abdominal wall to minimize internal conflict and maximize range of motion. Control of the robotic arms was reassigned on the robotic console to create a more intuitive surgical approach. The robotic camera was rotated and positioned vertically to reduce external conflict and enhance visualization. RESULTS: Robotic-assisted single-incision laparoscopic partial cecectomy was performed in a 53 year-old male without complication or need for conversion. The procedure required 120 min with an estimated blood loss of < 50 ml. Pathology revealed a sessile tubular adenoma of the cecum. The length of hospital stay was 2 days and no complications were encountered. The patient returned with a well-healed 2.5 cm incision and no postoperative complications at 6 weeks follow-up. CONCLUSIONS: With appropriate modifications, robotic-assisted single-incision laparoscopic surgery may be applicable as a minimally invasive modality for partial colectomy. Further studies are warranted to establish the safety, efficacy, benefits, and limits of this technique. Copyright (c) 2010 John Wiley & Sons, Ltd.

“Different assistance concepts for rigid endoscopes: Technical point of view.”

“Prospects in Percutaneous Ablative Targeting: Comparison of a Computer-Assisted Navigation System and the AcuBot Robotic System.”

Pollock, R., P. Mozer, et al. (2010).

Journal of Endourology 24(8): 1269-1272.

Abstract Aim: Precise targeting is essential for adequate treatment of lesions during image-guided therapy. The aim of this study was to compare the performance of two emerging image-guided targeting technologies in a phantom model. Materials and Methods: A computer-assisted navigation system and AcuBot were tested using three operators: an interventional radiologist and two endourologists. Fiducials were placed in an anatomic gelatin phantom and targeted by both systems. The images were reconstructed and analyzed using a specialized software package (Amira; Visage Imaging, Carlsbad, CA). Accuracy was assessed by measuring proximity of the tip of the needle to the fiducial on computed-tomography-guided imaging. Accuracy and time to target were quantified and compared. Results: The mean distance from the desired target for AcuBot was 1.2 mm (range: 0.39-2.82). The mean distance from the desired target for the navigation system was 5.8 mm (range: 1.8-11.9). The AcuBot was significantly more accurate than the navigation system (p < 0.0001). The mean time from target acquisition to needle placement was 37 seconds (range: 15-75) for the AcuBot and 108 seconds (range: 45-315) for the navigation system (p = 0.001). Conclusion: Emerging technologies hold promise for increased accuracy during percutaneous targeted procedures. Both the AcuBot and the computer-assisted navigation system were accurate and efficient in a phantom targeting model. AcuBot was significantly more accurate, faster, and less user dependent than the navigation system. Further studies in animal and clinical studies are warranted to further advance this promising technology.

PURPOSE: We describe a comparative study between an enhanced air-cushion tactile sensor and a wheeled indentation probe. These laparoscopic tools are designed to rapidly locate soft-tissue abnormalities during minimally invasive surgery (MIS). MATERIALS AND METHODS: The air-cushion tactile sensor consists of an optically based sensor with a 7.8 mm sphere “floating” on a cushion of air at the tip of a shaft. The wheeled indentation probe is a 10 mm wide and 5 mm in diameter wheel mounted to a force/torque sensor. A continuous rolling indentation technique is used to pass the sensors over the soft-tissue surfaces. The variations in stiffness of the viscoelastic materials that are detected during the rolling indentations are illustrated by stiffness maps that can be used for tissue diagnosis. The probes were tested by having to detect four embedded nodules in a silicone phantom. Each probe was attached to a robotic manipulator and rolled over the silicone phantom in parallel paths. The readings of each probe collected during the process of rolling indentation were used to achieve the final results. RESULTS: The results show that both sensors reliably detected the areas of variable stiffness by accurately identifying the location of each nodule. These are illustrated in the form of two three-dimensional spatiomechanical maps. CONCLUSIONS: These probes have the potential to be used in MIS because they could provide surgeons with information on the mechanical properties of soft tissue, consequently enhancing the reduction in haptic feedback.